Advance Directive Care Home and Hospital Admission UK

Why Transitions Are When Documents Get Lost

Moving into a care home or being admitted to hospital are the two moments when an ADRT and LPA are most likely to be needed — and most likely to be missing from the patient's file.

Care home admissions are typically planned weeks in advance, which gives families time to prepare. Hospital admissions are often emergencies, which means documents need to be already on file. In both cases, the common failure mode is the same: the patient has valid documents, but the treating team cannot find them.

The practical barrier is that England has no central registry for ADRTs or LPAs. Each healthcare provider maintains its own records, and documents do not automatically transfer between GP surgeries, hospital trusts, and care homes. It falls to the family — or the patient, if they have capacity — to ensure every new care provider has a copy.

Care Home Admissions — What to Do Before the Move

When arranging a care home placement, include advance care planning documents in the admission paperwork alongside the care needs assessment, medication lists, and financial information.

Specifically:

1. Provide the care home with a certified copy of any registered LPA (both Health and Welfare, and Property and Financial Affairs if relevant). The care home manager needs to know who has authority to make decisions if the resident loses capacity. Without this, the care home's own staff make day-to-day care decisions under the "best interests" framework, which may not align with what the family expects.

2. Provide a copy of the ADRT. The care home should upload it to the resident's care plan and flag it for all care staff. If the ADRT covers life-sustaining treatment — refusing CPR, refusing artificial nutrition and hydration, or refusing hospitalisation — the care home's clinical lead needs to be aware and prepared to communicate these refusals to ambulance crews and hospital teams if the resident is transferred.

3. Confirm whether the care home participates in the ReSPECT process. Many care homes in England now use ReSPECT forms to document emergency care preferences. A ReSPECT form does not replace an ADRT (the ReSPECT form is not legally binding, while a valid ADRT is), but it provides a clinical summary that paramedics can access quickly. The ADRT should be referenced in the ReSPECT form, not superseded by it.

4. Notify the new GP surgery. If the care home is in a different area, the resident will be registered with a new GP practice. The new surgery needs copies of all planning documents, and the ADRT must be flagged on the electronic patient record — the same process as the original GP registration.

Hospital Admissions — Planned and Emergency

Planned admissions (scheduled surgery, diagnostic procedures, planned treatments) give the family time to act. Before the admission date:

• Call the ward or pre-admission team and ask how to ensure advance planning documents are on the patient's hospital file
• Bring certified copies of the ADRT and registered LPA to the pre-admission appointment
• Ask the admitting doctor to note the documents in the patient's electronic record for that trust
• If the admission involves a procedure covered by the ADRT's treatment refusals, ensure the surgical or anaesthetic team is aware before the procedure begins

Emergency admissions are harder. If the patient arrives by ambulance without family present, the A&E team works with whatever is in the NHS electronic systems. This is why the GP registration step is so critical — if the ADRT is flagged on the Summary Care Record, emergency doctors can access it.

When family members arrive at the hospital after an emergency admission:

• Immediately inform the clinical team that the patient has an ADRT and/or a registered LPA
• Provide a copy if you have one with you, or give the clinical team your GP surgery's contact details so they can retrieve the documents
• If the patient's ADRT covers treatment currently being administered or considered, make this known urgently — the clinical team is legally required to check the document's validity and applicability before proceeding with treatment the patient has refused

The Transition Gap Between Settings

The most dangerous moment is the transfer between care settings — care home to hospital, hospital to hospital, hospital back to care home. Each time a patient crosses an institutional boundary, their planning documents may not follow.

During hospital discharge back to a care home, check that:

• Any new treatment decisions made during the hospital stay are communicated to the care home
• The ADRT has not been misplaced or misfiled during the admission
• If a ReSPECT form was created or updated during the hospital stay, the updated version is sent to the care home and GP surgery

Families acting as Health and Welfare attorneys have the authority to demand that these documents are transferred and recorded. You are not asking a favour — you are exercising a legal power.

Our England Advance Directive guide includes a care transition checklist covering both planned and emergency scenarios, along with a document distribution tracker that records which provider has which version of your ADRT and LPA.

See more England guides →